Abstract No. 145: Radiation Dose of Uterine Fibroid Embolization Using a Flat Panel Digital Subtraction Angiography System

Mondshine, Ross T.; Charles, H.; Aquino, T.; Clark, Timothy W.I.

doi:10.1016/j.jvir.2007.12.161

Cited by 3 publications

(4 citation statements)

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“…Both studies produced notable statistically significant outcomes with minimising radiation exposure to the UFE patients and demonstrates that flat–panel angiography units are more superior to conventional angiography units. Another study by Mondshine et al also found that the technology was associated with a decreased cumulative dose (0.78 Gy) and skin DAPs (146.35 Gy cm 2 ) on their flat–panel angiography system (Axiom Artis, Siemens Medical Systems, Germany). Recent literature by Schernthaner et al , published in 2018 supports previous findings that the flat–panel angiography units produce significantly improved image quality and reduced radiation exposure.…”

Section: Discussionmentioning

confidence: 94%

“…Modern and emerging interventional angiography suites have changed from conventional image intensifiers and fluoroscopy units, to c‐arm angiographic systems with flat–panel detectors and integrated automatic exposure control (AEC). Performing a UAE procedure using flat–panel technology yields a wider dynamic range, improved modulation transfer function and decreased image lag compared to image intensifier angiography . These improvements have the potential to yield enhanced image quality and result in lower radiation exposure to the UAE patient.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the advent and presence of flat‐panel x‐ray units in the angiography suites, several studies have been published to date which compares the use of this technology to conventional angiography units during UAE. Most of the literature revolves around radiation dose and the common method of measuring and recording the AK, DAP and fluoroscopy time . Such methods and analysis improve upon the limitations of findings by Firouznia et al .…”

Section: Discussionmentioning

confidence: 99%

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The factors contributing to the total radiation exposure of patients during uterine artery embolisation

Nocum

Robinson

Liang

et al. 2019

J of Medical Radiation Sci

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Uterine artery embolisation (UAE) is an interventional angiography procedure for the treatment of symptomatic fibroids and/or adenomyosis in women. UAE is a less invasive and non‐surgical alternative to hysterectomy or myomectomy. However, ionising radiation is used for both fluoroscopic and angiographic image guidance to visualise and access the uterine arteries for embolisation and treatment of these benign conditions. Identifying the contributors and implementing dose reduction techniques are particularly important as UAE patients are usually of child‐bearing age. The purpose of this review was to examine the progression of literature on radiation exposure measurements and identifying the factors contributing to the total radiation exposure of female patients undergoing UAE. A Medline, ProQuest Central, ScienceDirect and Scopus database search from 2000 to 2018 was performed and forty articles were deemed acceptable for review following the inclusion and exclusion criteria set. UAE is a viable alternative to hysterectomy and myomectomy, as the reviewed literature demonstrated that the reported radiation exposure doses appear to be below the threshold for any deterministic radiation risks. The total radiation exposure of UAE patients is affected independently by multiple patient, operator expertise and technique, angiographic imaging and x‐ray unit variables. Uterus preservation can be attained post‐UAE with dose reduction and optimisation, however, a longitudinal study on UAE patients and their risk of radiation‐induced deterministic and/or stochastic effects is recommended.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The factors contributing to the total radiation exposure of patients during uterine artery embolisation

Nocum

Robinson

Liang

et al. 2019

J of Medical Radiation Sci

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“…Scheurig-Muenkler et al [24] suggested that the use of modern angiography systems and strict application of dose reduction methodology led to a significantly lower radiation dose, and therefore the target KAP should be kept below 50 Gy cm 2 . The reported dose reductions in this study for KAP (M = 52.9 Gy cm 2 ; median = 30.6 Gy cm 2 ) and Ka, r (M = 0.2 Gy; median = 0.14 Gy) are considerably lower than the mean values from previous studies where an upgraded angiography system was used, such as Durrani et al [32] (KAP = 206 Gy cm 2 ), Schernthaner et al [33] (KAP = 146 Gy cm 2 ; Ka, r = 0.6 Gy), Thomaere et al [34] (KAP = 102 Gy cm 2 ; Ka, r not reported), Kohlbrenner et al [35] (KAP = 175 Gy cm 2 ; Ka, r = 1.1 Gy), Sapoval et al [36] (KAP = 146 Gy cm 2 and Ka, r = 0.6 Gy), and Mondshine et al [37] (KAP = 146 Gy•cm 2 ; Ka, r = 0.8 Gy). The Azurion 7 M20 with FlexArm features ClarityIQ (Philips Healthcare, Eindhoven, Netherlands), which allows for achieving clear angiographic visibility at low x-ray dose levels for patients of different sizes.…”

Section: Discussionmentioning

confidence: 95%

Predictors of radiation dose for uterine artery embolisation are angiography system-dependent

Nocum¹,

Robinson²,

Halaki³

et al. 2022

J. Radiol. Prot.

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This study sought to achieve radiation dose reductions for patients receiving uterine artery embolisation (UAE) by evaluating radiation dose measurements for the preceding generation (Allura) and upgraded (Azurion) angiography system. Previous UAE regression models in the literature could not be applied to this centre’s practice due to being based on different angiography systems and radiation dose predictor variables. The aims of this study were to establish whether radiation dose is reduced with the upgraded angiography system and to develop a regression model to determine predictors of radiation dose specific to the upgraded angiography system. A comparison between Group I (Allura, n = 95) and Group II (Azurion, n = 95) demonstrated a significant reduction in KAP (kerma-area product) and Ka, r (reference air kerma) by 63% (143.2 Gy·cm2 vs 52.9 Gy·cm2; P < 0.001, d = 0.8) and 67% (0.6 Gy vs 0.2 Gy; P < 0.001, d = 0.8), respectively. The multivariable linear regression (MLR) model identified the UAE radiation dose predictors for KAP on the upgraded angiography system as total fluoroscopy dose, Ka, r, and total uterus volume. The predictive accuracy of the MLR model was assessed using a Bland-Altman plot. The mean difference was 0.39 Gy·cm2 and the limits of agreement (LoA) were +28.49 and -27.71 Gy·cm2, and thus illustrated no proportional bias. Our findings validated the upgraded angiography system and its advance capabilities to significantly reduce radiation dose for our patients. Interventional radiologist and interventional radiographer familiarisation of the system’s features and the implementation of the newly established MLR model would further facilitate dose optimisation for all centres performing UAE procedures using the upgraded angiography system.

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Retrospective case–control study on radiation dose for uterine artery embolization procedures

Nocum,

Liang

2024

J Med Imag Rad Onc

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IntroductionUterine artery embolization is performed in pre‐menopausal women. Understanding the contribution of radiation dose at each stage of the procedure is important for potential dose reduction. The aim was to retrospectively analyse radiation dose on a per‐procedural‐stage basis, comparing digital subtraction angiography (DSA) and conventional roadmap (CRM).MethodsGroup A consisted of 50 patients where DSA was used for road mapping at all stages: (I) Aortogram, (II) Left internal iliac artery (IIA) DSA, (III) Left uterine artery (UA) DSA, (IV) Right IIA DSA and (V) Right UA DSA. Group B included 50 patients, where CRM was used for road mapping at stages (II) and (IV).ResultsFor Group A, mean total dose‐area product (DAP) was 39.7 Gy·cm2; mean DAP for each stage were (I) Aortogram = 3.4 Gy·cm2, (II) Left IIA DSA = 5.9 Gy·cm2, (III) Left UA DSA = 3.2 Gy·cm2, (IV) Right IIA DSA = 5.5 Gy·cm2 and (V) Right UA DSA = 3.0 Gy·cm2. For Group B, mean total DAP was 33.6 Gy·cm2, mean DAP for each stage were (I) Aortogram = 3.3 Gy·cm2, (II) Left IIA CRM = 1.5 Gy·cm2, (III) Left UA DSA = 3.3 Gy·cm2, (IV) Right IIA CRM = 1.5 Gy·cm2 and (V) Right UA DSA = 3.3 Gy·cm2. Fluoroscopy time was 10 and 9.4 min for Groups A and B, respectively.ConclusionThe highest road‐mapping radiation dose contribution was from bilateral IIA DSA. The use of CRM, intermittent fluoroscopy and elimination of the aortogram is recommended to further reduce procedural radiation dose.

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Abstract No. 145: Radiation Dose of Uterine Fibroid Embolization Using a Flat Panel Digital Subtraction Angiography System

Cited by 3 publications

References 0 publications

The factors contributing to the total radiation exposure of patients during uterine artery embolisation

The factors contributing to the total radiation exposure of patients during uterine artery embolisation

Predictors of radiation dose for uterine artery embolisation are angiography system-dependent

Retrospective case–control study on radiation dose for uterine artery embolization procedures

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